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Biomedical subjects

Z Fireman

Publications and source records attributed to Z Fireman.

At least 73 records · Page 4Linked to original sources
PubMed1987

Familial colon cancer in the Tel-Aviv area and the influence of ethnic origin.

The family history of colon cancer was investigated in 38,823 individuals (2,129 families) who comprised a control and an oncology patient series from Tel-Aviv and nearby areas. A significant increased risk for colon cancer was observed among first-degree relatives of colon cancer patients when compared to controls. When the patient sample was divided into two groups based on country and continent of birth--European (Ashkenazim) and other (nonAshkenazim)--the relatives of the nonAshkenazi subjects showed a greater relative risk for colon cancer (P less than 0.05). Colon cancer was found to be less frequent in nonAshkenazim than in Ashkenazim controls. These findings suggest that although the colon cancer frequency in the nonAshkenazi group is lower, the genetic component may be more important than for the Ashkenazi sample. The nonAshkenazi Jews may represent distinct subgroups that differ with respect to either primary genetic susceptibility to colorectal cancer and/or they may have been subjected to peculiar, environmental carcinogenic exposures when compared to their Ashkenazim brethren.

Adult↗
PubMed1987

Family history of colorectal cancer as a marker of potential malignancy within a screening program.

Epidemiologic studies have shown that asymptomatic adult relatives of colorectal cancer patients are at increased risk for developing this tumor. A prospective, published pilot study confirmed this added risk and demonstrated the importance of the family history of cancer as a marker of potential malignancy. The study group was enlarged to include 471 asymptomatic adult, first degree relatives of patients having large bowel neoplasia (cancer or adenomatous polyps) but without polyposis syndromes. These first degree relatives were screened by fecal occult blood examinations and flexible sigmoidoscopy, followed by colonoscopy when indicated. Adenomatous polyps or cancer were found in 8.1% of the study group as compared with 3.7% in a comparison group of screens, not having the same family history of neoplasia and undergoing similar screening tests. Of the study group the age-adjusted rate for colorectal adenomas or cancer increased threefold (P less than 0.001) for subjects older than 40 years and an even higher fivefold relative risk was found for large bowel cancer only (P = 0.01). This was true even if there was only one relative with colorectal neoplasia (P less than 0.01) but was even more pronounced among those having more than one affected relative. The results confirm the usefulness of the family history, of even one member with large bowel neoplasia, in isolating a group at high risk for these lesions. This group would most likely benefit from regular cancer and adenomatous polyp screening particularly when older than 40 years.

Adenomatous Polyposis Coli↗
PubMed1987

A comparative study of metronidazole and sulfasalazine in active, not severe, ulcerative colitis. An Israeli multicenter trial.

Since metronidazole (M) was found to be effective in Crohn's disease, we evaluated its efficacy in the treatment of active ulcerative colitis (UC). Forty-six outpatients with acute, nonsevere UC were studied. Forty-two concluded the trial. Twenty-three received M 1.35 g/day and 19 received sulfasalazine (S) 4.5 g/day for 28 days in a randomized double-blind study. Six of 23 receiving M improved (26%) as against 13 of 19 patients receiving S (68%) (p less than 0.01). No significant side effects were noted. We conclude that M is ineffective in the therapy of an acute attack of UC.

Acute Disease↗
PubMed1987

Diagnostic gastrointestinal laparoscopy: experience and changing indications.

We reviewed the records of all 117 patients who underwent diagnostic laparoscopy at our clinic from 1980 to 1985. There were no deaths or marked complications from the procedure. Accurate diagnosis was made in 72% of 79 patients with abdominal pathology; of these, 81% of 63 patients had hepatic pathology, and 44% of 16 patients had extrahepatic pathology. Of 27 patients with conditions that might have justified exploratory laparotomy, diagnosis was made in 48%. Of 29 patients who underwent preceding nondiagnostic blind-needle biopsies of the liver, laparoscopy established a diagnosis of cirrhosis or neoplasm in 44%. A parenthetical finding was that at our institution liver scan alone appeared to be the most adequate imaging workup of suspected hepatic disease. Our data support the use of laparoscopy for diagnosis of hepatic disease and as a first step prior to purely diagnostic laparotomy.

Adult↗
PubMed1986

Colorectal tumor screening in women with a past history of breast, uterine, or ovarian malignancies.

Epidemiologic studies have shown that women who have successfully recovered from breast, uterine, or ovarian cancer have about twice the expected risk of developing colorectal cancer. These high-risk women were entered, therefore, into a large bowel screening program based on fecal occult blood detection, flexible sigmoidoscopy, and colonoscopy, when appropriate. The study group consisted of 183 women and the results were compared with 252 comparison subjects of similar age and ethnic origin. Neoplastic lesions, adenomatous polyps, or cancer were 2.5 times more frequent in the study group. However, for the largest group, women with a past history of breast cancer, the relative risk, adjusted for a family history of gastrointestinal cancer, was 3.0 (P = 0.03). This pilot study confirms the value of continuing to screen these patients, especially those with a positive family history of gastrointestinal malignancies. However, for psychological and administrative reasons, it may be better that their colon screening be integrated into a combined colon, breast, and gynecologic tumor follow-up, and not be part of a separate service.

Aged↗
PubMed1986

Antitumor immune response to colorectal cancer antigen detected by the leukocyte adherence inhibition test (LAI) in groups at high risk for colorectal cancer.

Colorectal cancer is the second leading cause of cancer death in western populations. As treatment outcome is highly correlated with stage at diagnosis, early detection is a very important task. Three high-risk groups for colorectal cancer (first-degree relatives of colorectal cancer patients; individuals with past history of colorectal neoplasms, polyps, or carcinoma; and patients with ulcerative colitis) were screened for colonic neoplasms. The study program included the leukocyte adherence inhibition test (LAI), a specific immune response test for colorectal cancer antigen; fiberoptic sigmoidoscopy or colonoscopy; and guaiac impregnated slide test. The main finding was the detection of 92 positive LAI tests out of 451 high-risk individuals tested (20%), compared to eight positive tests out of 194 (4.1%) in a control group. Fifty-six colonic neoplasms were found out of 344 (16%) colonoscopies performed, most of them adenomatous polyps and a few carcinomas. Our findings, compared with the expected 2-3% neoplasms in low-risk groups, would prove that the screenees were indeed at high risk. However, only 11/56 (19%) of the polyps identified were LAI positive. The number of polyps found among LAI positive individuals were, so far, 11/92 (11%). The guaiac impregnated slide test for occult blood in the stool was performed in 221 screenees. Of these only 10 were positive (4.5%) compared with the average of 1% positive tests in low-risk groups.

Antigens, Neoplasm↗
PubMed1982

The causes of hypoxemia in elderly patients during endoscopy.

Changes in arterial gas tensions were determined in 114 patients undergoing elective gastrointestinal endoscopic examinations with standard or pediatric gastroscopes or colonoscopes. All patients were premedicated intravenously with 0.5 mg of atropine and 10 mg of diazepam. In addition, two thirds received a narcotic, either 50 mg of meperidine or 0.05 mg of the short acting drug fentanyl. The choice of instrument or premedication was usually sequential. There was significant depression of the arterial oxygen tension (Pao2), of 17.4%, immediately following premedication that included a narcotic but not with diazepam alone. Significant reduction of the Pao2 persisted during upper endoscopy if a standard gastroscope was used and meperidine or fentanyl was included in the premedication. If a narrow diameter gastroscope was employed, only meperidine was associated with persistent depression of the Pao2. To minimize hypoxia in elderly patients during upper endoscopy, no narcotic or only a short acting one should be included in their premedication, and a narrow diameter instrument should be used for the examination.

Aged↗
PubMed1981

Selective screening for colorectal tumors in the Tel-Aviv area: relevance of epidemiology and family history.

A selective screening program for the early detection of colorectal tumors was carried out in the Tel-Aviv area. The criteria for inclusion were based, in part, on relevant epidemiologic data which showed that European- and American-born immigrants were at the highest risk for developing this cancer, followed by Israel-born Jews. The Tel-Aviv area, because of its large elderly population of European origin, has a high incidence of colorectal cancer. Families of patients with colon cancer are known to have an increased risk for developing colon tumors. These relatives were actively searched for, and were, along with the control group, examined by Hemoccult testing and flexible sigmoidoscopy. The color tumor (cancer or adenomatous polyps) rate was 6.3% in the group with a family history of colon cancer, as contrasted to 3.8% in a smaller control group without this history. This increased yield, greater than usually found in an unselected population, emphasizes the economic value of selective screening utilizing relevant epidemiologic data and the family history.

Adult↗
PubMed1981

Lethal occult pulmonary hemorrhage in drug-induced thrombocytopenia.

A patient with drug-induced thrombocytopenia who died because of massive pulmonary hemorrhage is described. The patient had a clinical picture of acute respiratory distress resembling pulmonary edema, but there was no hemoptysis. Chest x-ray films showed granular density in the pulmonary fields, and the electrocardiograms revealed a pattern of acute biatrial enlargement. The diagnosis was confirmed at autopsy.

Acute Disease↗
PubMed1981

Arterial oxygen tension changes in elderly patients undergoing upper gastrointestinal endoscopy. II. Influence of the narcotic premedication and endoscope diameter.

Changes in arterial oxygen and carbon dioxide tensions were determined in 56 patients, mean age 67 years, during elective upper gastrointestinal endoscopy with standard or pediatric instruments. All the patients received intravenous atropine, diazepam, and either meperidine or fentanyl premedication. There was an immediate and significant fall in PaO2 levels (20.3%-16.5%) after both narcotic injections. The oxygen tension remained significantly depressed during the endoscopic examinations except in the group receiving fentanyl premedication and examined with the narrow pediatric instrument. To minimize hypoxemia in elderly patients during endoscopy, a short-acting narcotic or, preferably, no narcotic at all should be used in the premedication, and a narrow, pediatric instrument be used.

Aged↗